Ask the Doctors August 2006 Issue

Story Tools

Brian Donley, M.D.

Donley is Vice Chair- man of the Department of Orthopaedic Surgery at The Cleveland Clinic.

Chad Deal, M.D.

Deal is Head of the Center for Osteo- porosis and Metabolic Bone Disease at The Cleveland Clinic.

Ask the Doctors: 08/06

I have arthritis in both my thumbs, and my doctor wants to operate. What is the surgery’s success rate, and what other options do I have?

Many people with mild symptoms of thumb arthritis improve with a limited period of anti-inflammatory medication and avoidance of painful activities, with or without some type of splint. A cortisone injection into the sore area usually is helpful, at least temporarily. Relief usually lasts about two months. One or two injections provide permanent relief for about 50 percent of people with this problem.

When conservative treatment is no longer effective, surgery may be your only option. The most commonly performed surgery for thumb arthritis involves removal of the arthritic surfaces and insertion of a material—your own tendon or a synthetic substance—between the two ends of the bones. The success rate for this procedure is about 90 percent. Another surgical procedure used for thumb arthritis is fusion of the two bones that make up the joint. This generally eliminates the painful symptoms but produces some loss of motion and joint stiffness.

Total joint replacements for the thumb have not been as successful as replacements of large joints, such as the hip and knee.

----------

I've had osteoarthritis in my lower spine for several years. I also have a heart condition. Are cortisone shots advisable?

Cortisone shots in the spine are usually given for two reasons. The first is spinal stenosis, a condition where the nerves are compressed by bones, ligaments, and disc material. The second is for osteoarthritis of the facet joints (the joints that join each vertebral body together). These types of injections do not cause heart problems, other than the stress that having the shots might have on the heart.

----------

My wrists have been severely damaged by arthritis. My doctor has recommended wrist fusion because he says a replacement is not as stable. But I’ve read about a new replacement procedure that appears to be effective. What’s your opinion—is fusion better than replacement?

Replacement of the wrist joint has not been as successful as replacement of other joints, such as the hip and knee, primarily because the wrist is a complex structure made of many small joints. Duplicating the motion of these joints with a strong, stable replacement has been difficult. Early implants had frequent problems with dislocation, tendon imbalance, continued pain, or other postoperative complications. Newer designs and techniques have minimized some of these problems.

The major disadvantage of total wrist replacement is that the implant can become loose or wear out, requiring additional surgery. On average, a wrist replacement can be expected to last 10 to 15 years with careful use.

The physical demands that you place on the wrist prosthesis will have an effect on how long the implant lasts. You often will not be able to use a hammer or pneumatic tools. You may only be able to lift a limited amount of weight. A fall on the outstretched hand can break the prosthesis, just as it might fracture a normal wrist.

Your activity requirements and the need for retaining motion in your wrists should be considered in choosing fusion or replacement. Whether you have arthritis in your shoulder and elbow joints also is a consideration, because these joints must compensate for wrist motion lost with fusion.